Robotic Surgery means computer/ Robotic assisted surgery.
It was developed to overcome the limitations of MAS and to enhance the capabilities of surgeons performing open Surgery History of Robotic surgery
The first robot to assist in surgery was the Arthrobot, which was developed and used for the first time in Vancouver in 1983.[43] Intimately involved were biomedical engineer, Dr. James McEwen, Geof Auchinleck, a UBC engineering physics grad, and Dr. Brian Day as well as a team of engineering students. The robot was used in an orthopaedic surgical procedure on 12 March 1984, at the UBC Hospital in Vancouver.
Over 60 arthroscopic surgical procedures were performed in the first 12 months, and a 1985 National Geographic video on industrial robots, The Robotics Revolution, featured the device. Other related robotic devices developed at the same time included a surgical scrub nurse robot, which handed operative instruments on voice command, and a medical laboratory robotic arm. A YouTube video entitled Arthrobot illustrates some of these in operation .
Robotic Surgery by muthugomathy and meenakshi shetti.Qualcomm
Here is the very animatedly designed Presentation that explains briefly about Robotic Surgery , Uses of Robobic Surgery, Robotic Surgery Advantages and Disadvantages and about its future scope.
Robotic Surgery(minimally invasive surgery)Sgtm Saha
robotic surgery,minimally invasive surgery,MIS,the vinci surgical process,leproscopy surgey, 5 mins representation,BCDA College of pharmacy, SGTM, Swagatam Saha,WBUT Board,6th sem.
This document presents the robot Da Vinci the revolutionary endoscopic surgical device to assist remote control surgeries. Integrated Surgical Systems (now Intuitive Surgery, Inc.) redesigned the SRI Green Telepresence Surgery system and created the daVinci Surgical System classified as a master-slave surgical system. It uses true 3-D visualization and EndoWrist. It was approved by FDA in July 2000 for general laparoscopic surgery, in November 2002 for mitral valve repair surgery. The da Vinci robot is currently being used in various fields such as urology, general surgery, gynecology, cardio-thoracic, pediatric and ENT surgery. It provides several advantages to conventional laparoscopy such as 3D vision, motion scaling, intuitive movements, visual immersion and tremor filtration
Robotic Surgery by muthugomathy and meenakshi shetti.Qualcomm
Here is the very animatedly designed Presentation that explains briefly about Robotic Surgery , Uses of Robobic Surgery, Robotic Surgery Advantages and Disadvantages and about its future scope.
Robotic Surgery(minimally invasive surgery)Sgtm Saha
robotic surgery,minimally invasive surgery,MIS,the vinci surgical process,leproscopy surgey, 5 mins representation,BCDA College of pharmacy, SGTM, Swagatam Saha,WBUT Board,6th sem.
This document presents the robot Da Vinci the revolutionary endoscopic surgical device to assist remote control surgeries. Integrated Surgical Systems (now Intuitive Surgery, Inc.) redesigned the SRI Green Telepresence Surgery system and created the daVinci Surgical System classified as a master-slave surgical system. It uses true 3-D visualization and EndoWrist. It was approved by FDA in July 2000 for general laparoscopic surgery, in November 2002 for mitral valve repair surgery. The da Vinci robot is currently being used in various fields such as urology, general surgery, gynecology, cardio-thoracic, pediatric and ENT surgery. It provides several advantages to conventional laparoscopy such as 3D vision, motion scaling, intuitive movements, visual immersion and tremor filtration
It is a presentation of Robotic Surgery. Medical Science is using so many techniques for performing surgeries. Robotic Surgery is one of them. For detail document please send me mail...abhilashpillai13@gmail.com
Robotic surgery :-
Definition
limitations
History
Types
Applications
Advantages and disadvantages
Reference
,robotic surgery ,applications of robotic surgery ,advantages of robotic surgery ,disadvantages of robotic surgery ,uses of robotic surgery ,cardiac surgery ,gynecology ,neurosurgery ,radio surgery ,shared control robotic surgery ,da vinci robotic surgical system ,tele surgery system ,types of robotic surgery ,history of robotic surgery
Mills-Peninsula Health Services Cancer Symposium - Kimberly Moore Dalal, MD, FACS
Medical Director, Surgical Oncology Peninsula Medical Clinic Burlingame, CA
Minimally invasive liver surgery has recently acquired the surgical robot among the available weapons. In particular, the “Da Vinci” Robot currently represents the operative standard. Liver resections are now increasingly performed robotically. The increased experience has made these robotic procedures ever simpler and safer to perform. In this presentation, we review the basic steps for dealing with a robotic liver resection. The tools available to perform a robotic hepatectomy also occur. However, at the present time, the robotic surgical instruments completely studied and realized for their application on the liver are very few.
O. Glehen - HIPEC in colorectal carcinomatosisGlehen
Pr Olivier Glehen presents HIPEC in colorectal carcinomatosis in Slovenia 2013. Présentation de la CHIP dans la carcinose péritonéale d'origine colorectale.
We live in an age of a new unpreceded wonders. The wonders of the world are not seven any more. The inanimate talk to us. We are flying in the air. More than 65,000-Ton can float over the water in an iron vessel. The Robotic Doctor is already a reality. Reviewing the history of mankind's cumulative experience starting with the ancient very primitive trials and ending with the presence of Robotic and Telesurgery
Clearly show that the major and rapid advances in the whole mankind's life occur only in the last few decades especially the last 10 years ? .
Future of Surgery - The Emerging View 10 03 16Future Agenda
This is a new perspective on the future of surgery that builds on insights from the global 2015 Future Agenda programme as well as additional expert discussions in 2016 including an event held in Frankfurt on the 8 March.
It explores a number of different views of changes across healthcare that could impact surgery over the next ten years and is intended a catalyst for further discussions.
If you have perspectives to add, or alternative views to share, please do get in touch via email or twitter @futureagenda
It is a presentation of Robotic Surgery. Medical Science is using so many techniques for performing surgeries. Robotic Surgery is one of them. For detail document please send me mail...abhilashpillai13@gmail.com
Robotic surgery :-
Definition
limitations
History
Types
Applications
Advantages and disadvantages
Reference
,robotic surgery ,applications of robotic surgery ,advantages of robotic surgery ,disadvantages of robotic surgery ,uses of robotic surgery ,cardiac surgery ,gynecology ,neurosurgery ,radio surgery ,shared control robotic surgery ,da vinci robotic surgical system ,tele surgery system ,types of robotic surgery ,history of robotic surgery
Mills-Peninsula Health Services Cancer Symposium - Kimberly Moore Dalal, MD, FACS
Medical Director, Surgical Oncology Peninsula Medical Clinic Burlingame, CA
Minimally invasive liver surgery has recently acquired the surgical robot among the available weapons. In particular, the “Da Vinci” Robot currently represents the operative standard. Liver resections are now increasingly performed robotically. The increased experience has made these robotic procedures ever simpler and safer to perform. In this presentation, we review the basic steps for dealing with a robotic liver resection. The tools available to perform a robotic hepatectomy also occur. However, at the present time, the robotic surgical instruments completely studied and realized for their application on the liver are very few.
O. Glehen - HIPEC in colorectal carcinomatosisGlehen
Pr Olivier Glehen presents HIPEC in colorectal carcinomatosis in Slovenia 2013. Présentation de la CHIP dans la carcinose péritonéale d'origine colorectale.
We live in an age of a new unpreceded wonders. The wonders of the world are not seven any more. The inanimate talk to us. We are flying in the air. More than 65,000-Ton can float over the water in an iron vessel. The Robotic Doctor is already a reality. Reviewing the history of mankind's cumulative experience starting with the ancient very primitive trials and ending with the presence of Robotic and Telesurgery
Clearly show that the major and rapid advances in the whole mankind's life occur only in the last few decades especially the last 10 years ? .
Future of Surgery - The Emerging View 10 03 16Future Agenda
This is a new perspective on the future of surgery that builds on insights from the global 2015 Future Agenda programme as well as additional expert discussions in 2016 including an event held in Frankfurt on the 8 March.
It explores a number of different views of changes across healthcare that could impact surgery over the next ten years and is intended a catalyst for further discussions.
If you have perspectives to add, or alternative views to share, please do get in touch via email or twitter @futureagenda
Robotic surgery is a type of minimally invasive surgery. “Minimally invasive” means that instead of operating on patients through large incisions, we use miniaturized surgical instruments that fit through a series of quarter-inch incisions.
On July 11, 2000, the Food and Drug Administration (FDA) approved the first completely robotic surgery device, the da Vinci surgical system from Intuitive Surgical (Mountain View, CA).
The use of a robotic surgical system can provide added dexterity for delicate intraocular manipulations.
By Jean Pierre Hubschman, MD; Angelo Tsirbas, MD; and Steven D. Schwartz MD
Robotic colorectal surgery technique, advantages, disadvantages and its impac...Apollo Hospitals
The use of robotics in colorectal surgery is gaining momentum of late. Technical advances, such as three-dimensional imaging, a stable camera platform, excellent ergonomics, tremor elimination, ambidextrous capability, motion scaling and instruments with multiple degrees of freedom, have helped many surgeons adapt to it easily. There is a shorter learning curve compared to the standard laparoscopic surgery. This article helps to give an outline as to how robotic colorectal surgery can go a long way in the future of colorectal surgery.
Really putting such patients first means: 4 ensuring that such patients have continuity of care with a healthcare professional whom the patient knows and trusts; longer appointments as required;shared decision making and an agreed care plan; and easy access to care.
The presence of haematuria may be the sole symptom of an underlying disease, either benign or malignant. It is one of the most common presentations of patients with urinary tract diseases and of patients referred for urinary imaging. Painless visible haematuria (VH) is the commonest presentation of bladder cancer.
CBDSs are one of the medical conditions leading to surgical intervention. They may occur in 3%–14.7% of all patients for whom cholecystectomies are preformed. When patients present with CBD, the one important question that should be answered: what is the best modality of treatment under the giving conditions? There are competing technologies and approaches for diagnosing CBDS with regard to diagnostic performance characteristics, technical success, safety, and cost effectiveness. Management of CBDS usually requires two separate teams: the gastroenterologist and the surgical team. One of the main factors in the management is initially the detection of CBDS, before, during, or after cholecystectomy. The main options for treatment are pre- or postoperative ERCP with endoscopic biliary sphincterotomy (EST), laparoscopic or open surgical bile duct clearance. There are other options for the treat- ment of CBDS such as electrohydraulic lithotripsy (EHL), extracorporeal shockwave lithotripsy (ESWL), dissolving solutions, and laser lithotripsy. It is unlikely that one option
will be appropriate for all clinical circumstances in all centers. Variables such as disease status, patient demographics, availability of endoscopic, radiological and surgical expertise, and healthcare economics will all have significant influence on practice
The incidence of biliary injury after laparoscopic cholecystectomy (LC) has shown a declining trend though it may still be twice that as with open cholecystectomy. Major biliary or vasculobiliary injury is associated with significant morbidity. As prevention is the best strategy, the concept of a culture of safe cholecystectomy has been recently introduced to educate surgeons and apprise them of basic tenets of safe performance of LC. Various aspects of safe cholecystectomy include: (1) thorough knowledge of relevant anatomy, various anatomical landmarks, and anatomical variations; (2) an understanding of the mechanisms involved in biliary/vascular injury, the most important being the misidentification injury; (3) identification of various preoperative and intraoperative predictors of difficult cholecystectomy; (4) proper gallbladder retraction; (5) safe use of various energy devices; (6) understanding the critical view of safety, including its doublet view and documentation; (7) awareness of various error traps (e.g., fundus first technique); (8) use of various bailout strategies (e.g., subtotal cholecystectomy) in difficult gallbladder cases; (9) use of intraoperative imaging techniques (e.g., intraoperative cholangiogram) to ascertain correct anatomy; and (10) understanding the concept of time-out. Surgeons should be facile with these aspects of this culture of safety in cholecystectomy in an attempt to reduce the incidence of biliary/vascular injury during LC.
Ageing, also spelled aging, is the process of becoming older. The term refers especially to human beings, many animals, and fungi, whereas for example bacteria, perennial plants and some simple animals are potentially immortal. In the broader sense, ageing can refer to single cells within an organism which have ceased dividing (cellular senescence) or to the population of a species (population ageing).
In humans, ageing represents the accumulation of changes in a human being over time,[1] encompassing physical, psychological, and social change. Reaction time, for example, may slow with age, while knowledge of world events and wisdom may expand. Ageing is among the greatest known risk factors for most human diseases:[2] of the roughly 150,000 people who die each day across the globe, about two thirds die from age-related causes.
The causes of ageing are uncertain; current theories are assigned to the damage concept, whereby the accumulation of damage (such as DNA oxidation) may cause biological systems to fail, or to the programmed ageing concept, whereby internal processes (such as DNA methylation) may cause ageing. Programmed ageing should not be confused with programmed cell death (apoptosis).
As we enter in the Modern day, we are witnessing dawn of the new trend in which closed body operating procedures are more often being performed through minimal access. This development is the consequence of vision and work of many dedicated individuals. They include early pioneers of endoscopy who planted the seed and lastly the current pioneers who pushed and expanded these frontiers to give rise the birth of modern laparoscopy. Therapeutic laparoscopic surgery was introduced into the surgical practice recently and within a short span of time, it has become established as defacto standard for the treatment of chronic cholelithiasis and many advanced laparoscopic procedures can be performed safely. Laparoscopic surgery, what we should witness today, may be the culmination of over a hundred years of painstaking efforts from the number of pioneers within the fields of optics, instrumentation and video laparoscopic camera. Few advances in medicine occur in isolation. The innate human curiosity to peer within the body cavities can be traced back to ancient times. However, due to primitive technology and crude instruments, several ambitions were not realized. It is probably safe to say that first laparoscopy would not have been performed had it not been for the efforts of many physicians in 1800s to develop endoscope. The device developed by Theodore Stein in mid 1880 contains all the aspects of the current endoscopic documentation system. There was a crude endoscope and a high intensity light source. Illumination was made by continuously feeding a magnesium wire into an ignition chamber utilizing a clockwise mechanism. Light from this combustion was reflected to the tube utilizing a mirror. Finally the look was focused on to some photographic plate through coupling optics.
Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation. Severe constipation includes obstipation (failure to pass stools or gas) and fecal impaction, which can progress to bowel obstruction and become life-threatening.
Constipation is a symptom with many causes. These causes are of two types: obstructed defecation and colonic slow transit (or hypo mobility). About 50 percent of people evaluated for constipation at tertiary referral hospitals have obstructed defecation. This type of constipation has mechanical and functional causes. Causes of colonic slow transit constipation include diet, hormonal disorders such as hypothyroidism, side effects of medications, and rarely heavy metal toxicity. Because constipation is a symptom, not a disease, effective treatment of constipation may require first determining the cause. Treatments include changes in dietary habits, laxatives, enemas, biofeedback, and in particular situations surgery may be required.
Constipation is common; in the general population rates of constipation varies from 2–30 percent. In elderly people living in care homes the rate of constipation is 50–75 percent.[4] In the United States expenditures on medications for constipation are greater than US$250 million per year.
The definition of constipation includes the following:
infrequent bowel movements (typically three times or fewer per week)
difficulty during defecation (straining during more than 25% of bowel movements or a subjective sensation of hard stools; straining in this context is a strong effort to push out stool often by holding one's breath and by pushing the respective muscles in the abdominal area hard), or
the sensation of incomplete bowel evacuation.
The Rome III criteria are widely used to diagnose chronic constipation, and are helpful in separating cases of chronic functional constipation from less-serious instances.
Another definition states that less than three bowel movements per week and straining on more than 75% of occasions represents constipation in clinical surveys.
The Ideal Suture Material
Can be used in any tissue
Easy to handle
Good knot security
Minimal tissue reaction
Unfriendly to bacteria
Strong yet small
Won’t tear through tissues
Cheap
USES:
To bring tissue edges together and speed wound healing (=tissue apposition)
Orthopedic surgery to help stabilize joints
Repair ligaments
Ligate vessels or tis
Pancreatitis is a dreaded condition associated with development of acute and sudden inflammation of the pancreas.
Pancreatic enzymes are released in the abdomen and cause inflammation by the damage from digestion of normal body structures, especially fat in the abdomen.
Mortality ranges from 3 percent in patients with interstitial edematous pancreatitis to 17 percent in patients who develop pancreatic necrosis.
Every upcoming surgeon practising minimal access surgery should know the basics of urology , so that he or she can put his or her,s capabilities as a surgeon
Common symptoms of depression:
Lost of interest in the things that were previously pleasurable
Depressed and Sadness
Hopelessness
Other may Include:
Anxiety
Increased feeling of guilt
Irritability
Impatience
Sleep disturbances
Tearfulness
Difficulty concentrating
Appetite changes (loss/gain)
Increased Isolation
Somatic Pain
Substance abuse
Laparoscopic Urologic surgery, is a part of the curriculum of Minimal Access Surgery, and requires lot of skills and patience. All new surgeons carrying out Basic Laparoscopic surgery should aim at also doing Lap. Urological surgeries, which has a steep learning curve, but with with excellent outcomes.
This presentation was delivered at Puri on 10th january 2015
on the occasion of annual Rotary District Conference along with IMA Puri. It highlights on metabolic syndrome and its surgical solution.
What is MIS?
A minimally invasive medical procedure is defined as one that is carried out by entering the body through the skin or through a body cavity or anatomical opening, but with the smallest damage possible to these struct uresIncludes laparoscopic, endoscopic, and other approaches.
Why MIS?
Decreased patient pain
Decreased patient recovery period
Possible decrease in inflammatory response in the patient which may prove to have a better outcome in oncologic operations.
Distant future
In the distant future, there will be a para- digm shift with the development of non-inva- sive surgical techniques in combination with nanotechnologies and a new era in the devel- opment of surgery, and subsequently in surgi- cal techniques, will be opened.
Nanotechnology is an umbrella term for materials and devices that operate at the nanoskill (1 billionth of a meter). In terms of scale, a nanometer is approximately one 1/8000 of a human hair or 10 times the diam- eter of a hydrogen atom. The size of the device can vary but starts from a ten thou- sand-logic element system that will occupy a cube of no more than one hundred nanome- ters. This is a volume slightly larger than 0.001 cubic microns. This would be sufficient to hold a small computer. For example, if red blood cells are approximately eight microns in diameter, the 100 nanomicroprocessor will be 80 times smaller than a red blood cell. Devices this size could easily fit into the circulatory system and could even conceivably enter indi- vidual cells.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Why robotic bariatric SP
1. Robotic
3 D Surgery
DR SREEJOY PATNAIK
SAGES, ASMBS, ELSA, FAIS, FAMASI,
FIAGES
MINIMAL ACCESS SURGERY
( GASTRO INTESTINAL, BARIATRIC &
METABOLIC SURGERY )
SHANTI MEMORIAL HOSPITAL PVT. LTD,
CUTTACK, ODISHA, INDIA
2. Definition
Robotic Surgery means computer/ Robotic
assisted surgery.
It was developed to overcome the limitations
of MAS and to enhance the capabilities of
surgeons performing open Surgery.
3. History of Robotic surgery
The first robot to assist in surgery was the Arthrobot, which was developed and
used for the first time in Vancouver in 1983.[43] Intimately involved were
biomedical engineer, Dr. James McEwen, Geof Auchinleck, a UBC engineering
physics grad, and Dr. Brian Day as well as a team of engineering students. The
robot was used in an orthopaedic surgical procedure on 12 March 1984, at the
UBC Hospital in Vancouver.
Over 60 arthroscopic surgical procedures were performed in the first 12 months,
and a 1985 National Geographic video on industrial robots, The Robotics
Revolution, featured the device. Other related robotic devices developed at the
same time included a surgical scrub nurse robot, which handed operative
instruments on voice command, and a medical laboratory robotic arm. A YouTube
video entitled Arthrobot illustrates some of these in operation.
4. In 1985 a robot, the Unimation Puma 200, was used to place a needle for a brain biopsy using
CT guidance.[44] In 1992, the PROBOT, developed at Imperial College London, was used to
perform prostatic surgery by Dr. Senthil Nathan at Guy's and St Thomas' Hospital, London.
This was the first pure robotic surgery in the world. The ROBODOC from Integrated Surgical
Systems (working closely with IBM) was introduced in 1992 to mill out precise fittings in the
femur for hip replacement.[45] The purpose of the ROBODOC was to replace the previous
method of carving out a femur for an implant, the use of a mallet and broach/rasp.
Further development of robotic systems was carried out by SRI International and Intuitive
Surgical with the introduction of the da Vinci Surgical System and Computer Motion with the
AESOP and the ZEUS robotic surgical system.[46] The first robotic surgery took place at The
Ohio State University Medical Center in Columbus, Ohio under the direction of Robert E.
Michler
5. Examples of using ZEUS include a fallopian tube reconnection in July 1998,[48] a beating heart coronary
artery bypass graft in October 1999,[49] and the Lindbergh Operation, which was a cholecystectomy
performed remotely in September 2001.[50]
The original telesurgery robotic system that the da Vinci was based on was developed at SRI International
in Menlo Park with grant support from DARPA and NASA.[51] Although the telesurgical robot was originally
intended to facilitate remotely performed surgery in battlefield and other remote environments, it turned
out to be more useful for minimally invasive on-site surgery
The patents for the early prototype were sold to Intuitive Surgical in Mountain View, California. The da
Vinci senses the surgeon’s hand movements and translates them electronically into scaled-down micro-
movements to manipulate the tiny proprietary instruments. It also detects and filters out any tremors in
the surgeon's hand movements, so that they are not duplicated robotically. The camera used in the system
provides a true stereoscopic picture transmitted to a surgeon's console. Examples of using the da Vinci
system include the first robotically assisted heart bypass (performed in Germany) in May 1998, and the
first performed in the United States in September 1999;[citation needed] and the first all-robotic-assisted kidney
transplant, performed in January 2009.[52] The da Vinci Si was released in April 2009, and initially sold for
$1.75 million.[53]
6. In May 2006 the first artificial intelligence doctor-conducted unassisted robotic surgery on a
34 year old male to correct heart arythmia. The results were rated as better than an above-
average human surgeon. The machine had a database of 10,000 similar operations, and so, in
the words of its designers, was "more than qualified to operate on any patient".[54][55] In
August 2007, Dr. Sijo Parekattil of the Robotics Institute and Center for Urology (Winter
Haven Hospital and University of Florida) performed the first robotic assisted microsurgery
procedure denervation of the spermatic cord for chronic testicular pain.[56] In February 2008,
Dr. Mohan S. Gundeti of the University of Chicago Comer Children's Hospital performed the
first robotic pediatric neurogenic bladder reconstruction.[57]
On 12 May 2008, the first image-guided MR-compatible robotic neurosurgical procedure was
performed at University of Calgary by Dr. Garnette Sutherland using the NeuroArm.[58] In June
2008, the German Aerospace Centre (DLR) presented a robotic system for minimally invasive
surgery, the MiroSurge.[59] In September 2010, the Eindhoven University of Technology
announced the development of the Sofie surgical system, the first surgical robot to employ
force feedback.[60] In September 2010, the first robotic operation at the femoral
vasculature[disambiguation needed] was performed at the University Medical Centre
Ljubljana by a team led by Borut Geršak.[40][41]
8. Types of Robotic Surgery Systems
1. Supervisary controlled robotic surgery
systems.
2.Tele Surgical Systems:
- Da Vinci Robotic Surgical sysytem
- Zeus Robotic Surgical system
- AESOP Robotic Surgical system
3.Shared controlled Robotic Surgical system.
9. Supevisary Controlled Robotic System
Most automated one.
This system follows a specific set of instructions.
Surgeon should program the robot.
Surgeon should map the body of the patient in 3 different
ways, i.e;
1. Planning
2. Registration
3. Navigation
This system is precise in nature and reduces trauma.
Commonly used in hip & knee replacement procedures.
10. Planning, Registration & Navigation.
Planning :
Mapping the pt. body to the computer & to determine the
surgical pathway.
Registration:
Surgeon finds the points on the patients body.
Navigation:
Surgeon then activates the Robot.
13. Da Vinci Robotic Surgical sysytem
2 Primary components :
- A viewing and control console
- Surgical Arm unit ( 3 or 4 )
-Arm consists of camera with 2 lenses
- 3-D Image
Provides 7 deg. Of freedoms in
instruments.
14. Zeus Robotic Surgical system
Similar to Da Vinci
system.
Provides Voice
controlled capabilities.
Performs micro-
surgical tasks
15. AESOP Robotic Surgical system
Automated Endoscopic
System for Optical
Position.
Much simpler than Da
Vinci & Zues
Positions the
endoscope of a
surgical camera.
16. Shared controlled Robotic Surgical system.
Use of concept of active
constraint.
Defining regions on the patient:
Safe , close, boundary or
forbidden.
Surgeons concentrate on safe
regions.
17. Software Architecture
Presently Systems are based on linux 64- bit
platform.
MySql as Database.
Coin 3D for viewing 3D models.
18. Limitations of laparoscopic surgery
Dependence on assistant
for changing target
3rd arm repositioning by
assistant
No instrument wrists or
articulation
Instrument tip moves
sideways only
2D vision
20. Robot
4 arms
Central
camera arm
Arms 1,2 & 3
( two at a
time )
Shoulder,
elbow and
wrist
Instrument
with 2
fingers with
360 degree
movement
23. Parts of the setup
Robot Patient cart Surgeons console
24. • The term "robotic surgery" is used to refer to
the technology, but it is easy for people to get
the impression that the robot is the surgeon.
Who is the surgeon ?
25. • Actually, the current Robotic Surgical System
cannot run on its own. This is due to the fact it
was not designed as an autonomous system
and lacks decision making software.
26. Moreover, it reduces hand tremors and
movements which might have decreased the
preciseness of surgery.
Scale down movement and Intuitive
instrument movements.
ADVANTAGES
28. It is a less invasive
procedure and robotic arms
are much easier to use than
the instruments in
endoscopic surgery.
ADVANTAGES
29. Control of 4 robotic arms by the surgeon
makes co-ordination easier and less tiring
specially for advanced minimal access surgical
procedures.
ADVANTAGES
30. • A 3D vision right in front of the eyes where the
entire field in front of the surgeons face is the
operative area. This makes it easy to
concentrate.
• Three-dimensional magnification, resulting in
improved ergonomics.
ADVANTAGES
31. Surgeons console
3D ‘goggles’
Finger loops to
control instruments
and telescope
Arm rest with controls
Foot pedals for energy
devices, switch pedals
32.
33.
34.
35.
36. USES
General surgery[edit]
In early 2000 the field of general surgical interventions with the daVinci device was explored by surgeons at Ohio State
University. Reports were published in esophageal and pancreatic surgery for the first time in the world and further data
was subsequently published by Horgan and his group at the University of Illinois and then later at the same institution
by others.[8][9] In 2007, the University of Illinois at Chicago medical team, led by Prof. Pier Cristoforo Giulianotti,
reported a pancreatectomy and also the Midwest's first fully robotic Whipple surgery. In April 2008, the same team of
surgeons performed the world's first fully minimally invasive liver resection for living donor transplantation, removing
60% of the patient's liver, yet allowing him to leave the hospital just a couple of days after the procedure, in very good
condition. Furthermore the patient can also leave with less pain than a usual surgery due to the four puncture holes
and not a scar by a surgeon.[10]
Cardiothoracic surgery[edit]
Robot-assisted MIDCAB and Endoscopic coronary artery bypass (TECAB) operations are being performed with the
da Vinci system. Mitral valve repairs and replacements have been performed. The Ohio State University, Columbus
has performed CABG, mitral valve, esophagectomy, lung resection, tumor resections, among other robotic assisted
procedures and serves as a training site for other surgeons. In 2002, surgeons at the Cleveland Clinic in Florida
reported and published their preliminary experience with minimally invasive "hybrid" procedures. These procedures
combined robotic revascularization and coronary stenting and further expanded the role of robots in coronary
bypass to patients with disease in multiple vessels. Ongoing research on the outcomes of robotic assisted CABG
and hybrid CABG is being done.
37. USES
Colon and rectal surgery[edit]
Many studies have been undertaken in order to examine the role of robotic procedures in the field of colorectal
surgery.[16][17]
Results to date indicate that robotic-assisted colorectal procedures outcomes are "no worse" than the results in the
now "traditional" laparoscopic colorectal operations. Robotic-assisted colorectal surgery appears to be safe as well.[18]
Most of the procedures have been performed for malignant colon and rectal lesions. However, surgeons are now
moving into resections for diverticulitis and non-resective rectopexies (attaching the colon to the sacrum in order to
treat rectal prolapse.)
When evaluated for several variables, robotic-assisted procedures fare equally well when compared with laparoscopic,
or open abdominal operations. Study parameters have looked at intraoperative patient preparation time, length of time
to perform the operation, adequacy of the removed surgical specimen with respect to clear surgical margins and
number of lymph nodes removed, blood loss, operative or postoperative complications and long-term results.
More difficult to evaluate are issues related to the view of the operative field, the types of procedures that should be
performed using robotic assistance and the potential added cost for a robotic operation.
Many surgeons feel that the optics of the 3-dimensional, two camera stereo optic robotic system are superior to the
optical system used in laparoscopic procedures. The pelvic nerves are clearly visualized during robotic-assisted
procedures. Less clear however is whether or not these supposedly improved optics and visualization improve patient
outcomes with respect to postoperative impotence or incontinence, and whether long-term patient survival is improved
by using the 3-dimensional optic system. Additionally, there is often a need for a wider, or "larger" view of the
operative field than is routinely provided during robotic operations.,[19] The close-up view of the area under dissection
may hamper visualization of the "bigger view", especially with respect to ureteral protection.
Questions remain unanswered, even after many years of experience with robotic-assisted colorectal operations.
Ongoing studies may help clarify many of the issues of confusion associated with this novel surgical approach.
38. USES
Cardiology and electrophysiology[edit]
The Stereotaxis Magnetic Navigation System (MNS) has been developed to increase precision and safety in
ablation procedures for arrhythmias and atrial fibrillation while reducing radiation exposure for the patient and
physician, and the system utilizes two magnets to remotely steerable catheters. The system allows for
automated 3-D mapping of the heart and vasculature, and MNS has also been used in interventional
cardiology for guiding stents and leads in PCI and CTO procedures, proven to reduce contrast usage and
access tortuous anatomy unreachable by manual navigation. Dr. Andrea Natale has referred to the new
Stereotaxis procedures with the magnetic irrigated catheters as "revolutionary."[11]
The Hansen Medical Sensei robotic catheter system uses a remotely operated system of pulleys to navigate a
steerable sheath for catheter guidance. It allows precise and more forceful positioning of catheters used for 3-
D mapping of the heart and vasculature. The system provides doctors with estimated force feedback
information and feasible manipulation within the left atrium of the heart. The Sensei has been associated with
mixed acute success rates compared to manual, commensurate with higher procedural complications, longer
procedure times but lower fluoroscopy dosage to the patient.[12][13][14]
At present, three types of heart surgery are being performed on a routine basis using robotic surgery
systems.[15] These three surgery types are:
Atrial septal defect repair – the repair of a hole between the two upper chambers of the heart,
Mitral valve repair – the repair of the valve that prevents blood from regurgitating back into the upper heart
chambers during contractions of the heart,
Coronary artery bypass – rerouting of blood supply by bypassing blocked arteries that provide blood to the
heart.
As surgical experience and robotic technology develop, it is expected that the applications of robots in
cardiovascular surgery will expand.
39. USES
Gastrointestinal surgery[edit]
Multiple types of procedures have been performed with either the 'Zeus' or da Vinci robot
systems, including bariatric surgery and gastrectomy [20] for cancer. Surgeons at various
universities initially published case series demonstrating different techniques and the
feasibility of GI surgery using the robotic devices.[9] Specific procedures have been more fully
evaluated, specifically esophageal fundoplication for the treatment of gastroesophageal
reflux[21] and Heller myotomy for the treatment of achalasia.[22][23]
Other gastrointestinal procedures including colon resection, pancreatectomy, esophagectomy
and robotic approaches to pelvic disease have also been reported.
40. USES
Gynecology[edit]
Robotic surgery in gynecology is of uncertain benefit
with it being unclear if it affects rates of complications.
Gynecologic procedures may take longer with robot-
assisted surgery but may be associated with a shorter
hospital stay following hysterectomy.[24] In the United
States, robotic-assisted hysterectomy for benign
conditions has been shown to be more expensive than
conventional laparoscopic hysterectomy, with no
difference in overall rates of complications.[25]
This includes the use of the da Vinci surgical system in
benign gynecology and gynecologic oncology. Robotic
surgery can be used to treat fibroids, abnormal periods,
endometriosis, ovarian tumors, uterine prolapse, and
female cancers. Using the robotic system,
gynecologists can perform hysterectomies,
myomectomies, and lymph node biopsies.
41. USES
Neurosurgery[edit]
Several systems for stereotactic intervention are currently on the
market. The NeuroMate was the first neurosurgical robot,
commercially available in 1997.[26] Originally developed in
Grenoble by Alim-Louis_Benabid’s team, it is now owned by
Renishaw. With installations in the United States, Europe and
Japan, the system has been used in 8000 stereotactic brain
surgeries by 2009. IMRIS Inc.'s SYMBIS(TM) Surgical System[27]
will be the version of NeuroArm, the world’s first MRI-compatible
surgical robot, developed for world-wide commercialization.
Medtech's Rosa is being used by several institutions, including
the Cleveland Clinic in the U.S, and in Canada at Sherbrooke
University and the Montreal Neurological Institute and Hospital in
Montreal (MNI/H). Between June 2011 and September 2012,
over 150 neurosurgical procedures at the MNI/H have been
completed robotized stereotaxy, including in the placement of
depth electrodes in the treatment of epilepsy, selective
resections, and stereotaxic biopsies.
42. Orthopedics[edit]
The ROBODOC system was released in 1992 by Integrated
Surgical Systems, Inc. which merged into CUREXO Technology
Corporation.[28] Also, The Acrobot Company Ltd. developed the
"Acrobot Sculptor", a robot that constrained a bone cutting tool to
a pre-defined volume. The "Acrobot Sculptor" was sold to
Stanmore Implants in August 2010. Stanmore received FDA
clearance in February 2013 for US surgeries but sold the
Sculptor to Mako Surgical in June 2013 to resolve a patent
infringement lawsuit.[29] Another example is the CASPAR robot
produced by U.R.S.-Ortho GmbH & Co. KG, which is used for
total hip replacement, total knee replacement and anterior
cruciate ligament reconstruction.[30] MAKO Surgical Corp
(founded 2004) produces the RIO (Robotic Arm Interactive
Orthopedic System) which combines robotics, navigation, and
haptics for both partial knee and total hip replacement surgery.[31]
Blue Belt Technologies received FDA clearance in November
2012 for the Navio™ Surgical System. The Navio System is a
navigated, robotics-assisted surgical system that uses a CT free
approach to assist in partial knee replacement surgery.[32]
USES
43. Pediatrics[edit]
Surgical robotics has been used in many types of pediatric
surgical procedures including: tracheoesophageal fistula repair,
cholecystectomy, nissen fundoplication, morgagni's hernia repair,
kasai portoenterostomy, congenital diaphragmatic hernia repair,
and others. On 17 January 2002, surgeons at Children's Hospital
of Michigan in Detroit performed the nation's first advanced
computer-assisted robot-enhanced surgical procedure at a
children's hospital.
The Center for Robotic Surgery at Children's Hospital Boston
provides a high level of expertise in pediatric robotic surgery.
Specially-trained surgeons use a high-tech robot to perform
complex and delicate operations through very small surgical
openings. The results are less pain, faster recoveries, shorter
hospital stays, smaller scars, and happier patients and families.
In 2001, Children's Hospital Boston was the first pediatric
hospital to acquire a surgical robot. Today, surgeons use the
technology for many procedures and perform more pediatric
robotic operations than any other hospital in the world. Children's
Hospital physicians have developed a number of new
applications to expand the use of the robot, and train surgeons
from around the world on its use.[33]
USES
44. Radiosurgery[edit]
The CyberKnife Robotic Radiosurgery System uses image
guidance and computer controlled robotics to treat tumors
throughout the body by delivering multiple beams of high-energy
radiation to the tumor from virtually any direction. The system
uses a German KUKA KR 240. Mounted on the robot is a
compact X-band linac that produces 6MV X-ray radiation.
Mounting the radiation source on the robot allows very fast
repositioning of the source, which enables the system to deliver
radiation from many different directions without the need to move
both the patient and source as required by current gantry
configurations.
USES
45. Transplant surgery[edit]
Transplant surgery (organ transplantation) has been considered
as highly technically demanding and virtually unobtainable by
means of conventional laparoscopy. For many years, transplant
patients were unable to benefit from the advantages of minimally
invasive surgery. The development of robotic technology and its
associated high resolution capabilities, three dimensional visual
system, wrist type motion and fine instruments, gave opportunity
for highly complex procedures to be completed in a minimally
invasive fashion. Subsequently, the first fully robotic kidney
transplantations were performed in the late 2000s. After the
procedure was proven to be feasible and safe, the main
emerging challenge was to determine which patients would
benefit most from this robotic technique. As a result, recognition
of the increasing prevalence of obesity amongst patients with
kidney failure on hemodialysis posed a significant problem. Due
to the abundantly higher risk of complications after traditional
open kidney transplantation, obese patients were frequently
denied access to transplantation, which is the premium treatment
for end stage kidney disease. The use of the robotic-assisted
approach has allowed kidneys to be transplanted with minimal
incisions, which has virtually alleviated wound complications and
significantly shortened the recovery period. The University of
Illinois Medical Center reported the largest series of 104 robotic-
assisted kidney transplants for obese recipients (mean body
mass index > 42). Amongst this group of patients, no wound
infections were observed and the function of transplanted
kidneys was excellent. In this way, robotic kidney transplantation
could be considered as the biggest advance in surgical technique
for this procedure since its creation more than half a century
ago.[
USES
46. Urology[edit]
Robotic surgery in the field of urology has become very popular,
especially in the United States.[37] It has been most extensively
applied for excision of prostate cancer because of difficult
anatomical access. It is also utilized for kidney cancer surgeries
and to lesser extent surgeries of the bladder.
As of 2014, there is little evidence of increased benefits
compared to standard surgery to justify the increased costs.[38]
Some have found tentative evidence of more complete removal
of cancer and less side effects from surgery for prostatectomy.[39]
In 2000, the first robot-assisted laparoscopic radical
prostatectomy was performed.[5]
Vascular surgery[edit]
In September 2010, the first robotic operations with Hansen
Medical's Magellan Robotic System at the femoral
vasculature[disambiguation needed] were performed at the
University Medical Centre Ljubljana (UMC Ljubljana), Slovenia.
The research was led by Borut Geršak, the head of the
Department of Cardiovascular Surgery at the centre. Geršak
explained that the robot used was the first true robot in the
history of robotic surgery, meaning the user interface was not
resembling surgical instruments and the robot was not simply
imitating the movement of human hands but was guided by
pressing buttons, just like one would play a video game. The
robot was imported to Slovenia from the United States.[40][41]
USES
47. Miniature robotics[edit]
As scientists seek to improve
the versatility and utility of
robotics in surgery, some are
attempting to miniaturize the
robots. For example, the
University of Nebraska Medical
Center has led a multi-campus
effort to provide collaborative
research on mini-robotics
among surgeons, engineers and
computer scientists.[42]
USES
49. Summary
By providing surgeons with superior
visualization, enhanced dexterity, greater
precision and ergonomic comfort,
Surgical Robot makes it possible for more
surgeons to perform minimally invasive
procedures involving complex dissection or
reconstruction.
50. ARUN PRASAD, FRCS FRCSED MS (MAMC) MBBS (AFMC)
SENIOR CONSULTANT SURGEON - MINIMAL ACCESS SURGERY
GASTRO INTESTINAL, ROBOTIC, BARIATRIC & THORACOSCOPY
APOLLO HOSPITAL, NEW DELHI, INDIA